Brendan Ryan (Labour)

It is always easy at times like this to have a go at the Government for whatever failings or omissions were identified, particularly those in the area of private nursing home care. However, that is not what I should do in this regard. There is a need to reflect on how negligence and neglect can begin and be allowed to continue in any area of health care, but particularly in the support and care for elderly people.

It would be silly to point a finger at the Minister for Health and Children and claim it is her fault. Many things are her fault but the regime under which private nursing homes were regulated is not one of them. However, there is an underlying issue for which Government has responsibility and perhaps culpability, namely, the question of the apparent slowness, reluctance or unwillingness of families to complain about or demand what they believe are high standards, and the apparent uneasiness of families with regard to the consequences of complaining — I do not mean personal consequences.

In my case, when my mother needed institutional care — she needs it still, thank God — the system worked extremely smoothly through no influence of mine or anybody connected with me. However, I have observed the struggles, travails and trauma of many friends of mine, families I know and people I have met in my political life when the moment arrives and a much-loved parent clearly needs institutional care in some form of nursing home. There is the trauma of the struggle, often unsuccessful, to get subvention and the struggle to pay for the nursing home but, above all, there is the trauma of the struggle to find a place.

Having listened to people talk about the huge trauma of having to care for somebody who is bedridden and incontinent and the sense of life beginning to come back to something like normality because they have found a nursing home place, it is difficult to imagine such people being immediately vocal if they believe standards are not what they want them to be. It is not that they do not love and care for their elderly relatives. It is because they believe the choice is between what is unacceptable and what is an awful lot worse.

What we must do is create a system of support, regulation and inspection which makes the transition possible, where it is clearly necessary. The definition of when a person needs nursing care ought to be one that is capable of being shared by both the family and whoever makes that decision on behalf of the regulatory authorities, in order that we do not have a repetition of the extraordinary stories that arose in the past. For example, although it does not relate to this issue, there is the famous case involving excise relief for cars which were designed for people who had lost the use of their hands, arms or legs but, because of the wording, the Revenue Commissioners decided it did not apply to people who had lost limbs in more than one of the categories.

We must take a generous view based on common sense and this view must be inculcated in those who make decisions. Regulatory assessment of what people need cannot be determined by budgetary considerations but by the objective facts. Then it is the job of society to ensure that our old people are supported and sustained in quality care. Families can then be assured their expectation of quality care is not something they must suppress.

I do not want to prejudge the outcome of the investigation. However, looking at the situation from the outside, it is clear that good, caring children had considerable reservations, but did not know there was somewhere to go with their complaints. They could have taken their parents or elderly relatives from these premises, but there was no place else to put them. As a person with a mother who is old and feeble, I cannot imagine a worse dilemma than to have a much loved relative in an institution where the standard of care is so poor that one must complain. In such a case, one would inevitably be told that it was fine to take him or her away as there were ten or more people waiting for a place. The real function of the State in this area is to end this dilemma. I hope we achieve this as a result of the investigation.

There is no cheap solution to the dilemma. We must accept that as with primary education, maternity hospitals and other areas, the provision of hospital or institutionally-based care for people in the last years of their lives is part of what we must pay to be a civilised society. This can no longer be regarded as an exception or an add-on. Let us suppose, for example, we had a doubling of our birth rate. Would we suddenly announce we could not afford the extra maternity facilities this demanded or would we say it is something for which we must pay? I know we would say we must pay although I am not entirely sure I know what the current Minister would say as her views on public health care provision are far from clear. She has, with some justification, been accused of a kind of subterfuge in the privatisation of these services. Nevertheless, the majority of people in society would say the solution is better, namely, more extensive public provision when there is a need.

It is as easy to look at the care of old people as at maternity care. Why should old people be seen to be any more of a burden than a new baby? The language used by commentators, economists in particular, is inimical to the view that an old person in his or her last years is as precious to society as a newborn baby. There is an horrendous backward step for some economic commentators to suggest that a baby as a potentially productive unit in society must be nurtured, but an elderly person is a post-productive unit of society and is, therefore, a burden.

I hope the investigation will identify a process which will lead us to a situation where care for older people in institutions becomes part of a smooth, seamless transition through life, where maternity care is the beginning, followed by proper school and health services and proper adult health screening. There should be a smooth transition from phase to phase of life and no phase should be identified as a burden or become such a burden for caring relatives that it makes them afraid or discourages them from expecting the highest possible standards.